3 times per week dosing | Once per week dosing | |
Epoetin alfa (including biosimilars) | ||
Starting dose (adults) | 150 units/kg SUBQ 3 times per week | 40,000 units SUBQ once per week* |
Dose-reductions or interruptions | Reduce dose by 25% if the hemoglobin reaches a level needed to avoid RBC transfusion or increases >1 g/dL in any 2-week period. Withhold the dose if the hemoglobin exceeds a level needed to avoid RBC transfusion, and restart at 25% below the previous dose when the hemoglobin approaches a level where RBC transfusions may be required. | |
Dose increases | The dose can be increased after 4 weeks of therapy if the hemoglobin remains <10 g/dL and the rise in hemoglobin is <1 g/dL. Ensure iron stores are adequate. | |
Increase to 300 units/kg SUBQ 3 times per week | Increase to 60,000 units SUBQ once per week | |
Once per week dosing | Once every 3 weeks dosing | |
Darbepoetin alfa | ||
Starting dose (adults) | 2.25 micrograms/kg SUBQ once per week | 500 micrograms SUBQ once every 3 weeks |
Dose-reductions or interruptions | Reduce dose by 40% if the hemoglobin reaches a level needed to avoid RBC transfusion or increases >1 g/dL in any 2-week period. Withhold the dose if the hemoglobin exceeds a level needed to avoid RBC transfusion, and restart at 40% below the previous dose when the hemoglobin approaches a level where RBC transfusions may be required. | |
Dose increases | The dose can be increased after 6 weeks of therapy if the hemoglobin remains <10 g/dL and the rise in hemoglobin is <1 g/dL. Ensure iron stores are adequate. Increase to 4.5 micrograms/kg SUBQ once per week. | Dose increase not recommended |
In individuals with non-hematologic cancer, an ESA may be considered for treatment of symptomatic anemia with hemoglobin <10 g/dL that is induced by chemotherapy.
Refer to UpToDate for further information on the role of ESAs in non-hematologic cancers.
ESA: erythropoiesis-stimulating agent; RBC: red blood cell; SUBQ: subcutaneously.
* If initial therapy is tolerated and effective, extended dosing schedules may be used (eg, 80,000 units every 2 weeks or 120,000 units every 3 weeks).